pulmonary arterial hypertension Flashcards
pulmonary HPT
constant high pressure in PA >25mmhg
when vasoconsriction is >vaso dilator
no cure
what is the difference between primary hPT and primary PAH
Primary HPT is genetics whereas secondary PAH is genetics
what drugs can cause PAH
Cocaine
SSRI use during pregnancy
Weight loss drugsmeth/amphetamines
symptoms of PAH
fatigue,
dyspnea,
raynayds,
chest pain,
tachy cardia
non drug treatment
Sodium restriction <2.4 grams
volume status if right ventricular failure
maintain O2 above 90%
how is treatment determined in PAH
right heart catherterization using vaso dilators
what are some Drug treatments
long acting CCBs except Verapamil which causes negative ionotropic reaction
what to use if CCBs dont work for PAH
prostacycline analogs,
endothelin receptor antagonists
PDE-5 inhibitors
soluble guanylate cyclase stimulator
IV epoprostenol
what are some supportive therapies for PAH
loop diuretics
digoxin
warfarin with a goal of 1.5-2.5
what are some Prostacyclin analogues
potent vasodilators and inhibits platelet aggression
epoprostenol (flolan)
treprostinil (remodulin
iloprost Ventavis
selexipag Uptarvi
** parenteral agents avoid sudden changes
can cause rebound PH
what are some ERA endothelin receptor antagonists
bosentan (tracleer)
ambrisentan (letairis)
macitentan (opsumiit)
MOA -blocks endothelin receptors causing dilation
** Teratogenic require pregnancy test
**hepatoxic
PDE5s
sildenafil revatio
tadalafil adicirca
MOA - increases cGMP levels
** do not use with nitrates, can cause vision loss and hearing loss
soluble guanylate cyclase
riociguat adempas
** teratogenic, mus have a negative pregnancy test
MOA increases cgmp levels
do not use with nitrates and PDE5
what is pulmonary fibrosis
scarred damage tissue
what drugs can cause pulmoary fibrosis
amiodarone
bleomycin
carmustine
lomustine
